Heart Failure and Cardiomyopathy Unit, Heart Failure and Heart Transplant Section, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain.
Biostatistics Unit, Hospital Universitario Puerta de Hierro, Madrid, Spain.
JACC Heart Fail. 2015 Jan;3(1):78-86. doi: 10.1016/j.jchf.2014.07.014. Epub 2014 Nov 11.
This study sought to determine the natural history of contemporary alcoholic cardiomyopathy (ACM), to compare it with that of idiopathic dilated cardiomyopathy (IDCM), and to identify risk factors for poor outcome.
ACM is a common cause of dilated cardiomyopathy (DCM), but little is known about its natural history or the effect of reducing alcohol intake on disease progression.
We studied the clinical characteristics and outcomes of 94 consecutive patients with ACM and 188 with IDCM, evaluated over the period between 1993 and 2011.
After a median follow-up of 59 months (interquartile range: 25 to 107 months), 14 ACM patients (15%) had died from cardiovascular causes (6 from heart failure and 8 from sudden cardiac death), 14 (15%) underwent heart transplantation, 35 (37%) experienced recovery in left ventricular function, and 31 (33%) remained clinically stable without improvement in systolic function. Transplantation-free survival was higher in ACM patients than in IDCM patients (p = 0.002), and ACM was associated with a favorable outcome on multiple analysis of the entire cohort (odds ratio [OR]: 0.4; 95% confidence interval [CI]: 0.2 to 0.8; p = 0.01). Independent predictors of death or heart transplantation in ACM identified by multiple logistic regression analysis were atrial fibrillation (OR: 9.7; 95% CI: 2.56 to 36.79; p = 0.001); QRS duration >120 ms (OR: 7.2; 95% CI: 2.02 to 26; p = 0.002), and lack of beta-blocker therapy (OR: 4.4; 95% CI: 1.35 to 14.49; p = 0.014). ACM patients who reduced their alcohol intake to moderate levels exhibited similar survival (p = 0.22) and cardiac function recovery (p = 0.8) as abstainers.
ACM has a better prognosis than IDCM. Atrial fibrillation, QRS width >120 ms, and the absence of beta-blocker therapy identify patients with a poor outcome. Alcohol abstainers and those who reduce intake to a moderate degree show similar clinical outcomes.
本研究旨在确定当代酒精性心肌病（ACM）的自然病史，将其与特发性扩张型心肌病（IDCM）进行比较，并确定不良预后的危险因素。
ACM 是扩张型心肌病（DCM）的常见病因，但对其自然病史或减少饮酒对疾病进展的影响知之甚少。
我们研究了 94 例连续 ACM 患者和 188 例 IDCM 患者的临床特征和结局，这些患者在 1993 年至 2011 年期间进行了评估。
中位随访 59 个月（四分位距：25 至 107 个月）后，14 例 ACM 患者（15%）因心血管原因死亡（6 例死于心力衰竭，8 例死于心源性猝死），14 例（15%）接受心脏移植，35 例（37%）左心室功能恢复，31 例（33%）临床稳定，收缩功能无改善。ACM 患者的无移植生存率高于 IDCM 患者（p=0.002），在对整个队列进行的多项分析中，ACM 与良好的结局相关（比值比[OR]：0.4；95%置信区间[CI]：0.2 至 0.8；p=0.01）。多因素逻辑回归分析确定的 ACM 患者死亡或心脏移植的独立预测因素为心房颤动（OR：9.7；95%CI：2.56 至 36.79；p=0.001）；QRS 持续时间>120 ms（OR：7.2；95%CI：2.02 至 26；p=0.002），以及缺乏β受体阻滞剂治疗（OR：4.4；95%CI：1.35 至 14.49；p=0.014）。减少饮酒量至中等水平的 ACM 患者的生存率（p=0.22）和心功能恢复（p=0.8）与戒酒者相似。
ACM 的预后优于 IDCM。心房颤动、QRS 宽度>120 ms 和缺乏β受体阻滞剂治疗可识别预后不良的患者。戒酒者和减少饮酒量至中等程度的患者有相似的临床结局。
